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Objective: This study examined data from 4 sources: number of hospital-acquired conditions, patient perception of care, quality outcome measures, and demographic data to explain variances associated with 30-day pneumonia readmission rates., Background: Patients readmitted within 30 days for pneumonia increases the length of hospital stay by 7 to 9 days, increases crude mortality rate 30% to 70%, and costs of $40,000 or greater per patient., Methods: Variances in outcomes measures associated with 30-day pneumonia readmissions from 577 nonfederal general hospitals in Massachusetts, California, and New York were analyzed using datasets from Hospital Consumer Assessment of Healthcare Providers and Systems, Centers of Medicare & Medicaid Services, Agency for Healthcare Research and Quality, and American Hospital Association., Results: Three factors increased pneumonia readmission rates: poor nurse-patient communication, poor staff responsiveness to patient needs, and iatrogenic pneumothorax. Conversely, factors lowering pneumonia readmission rates included patients hospitalized in California, higher RN staffing, and higher proportions of nursing staff to total hospital personnel., Conclusion: Findings suggest lower nurse staffing, poor nurse-patient communication, and nurse responsiveness to patient needs contribute to increased pneumonia readmission rates.

In this study of California, Massachusetts, and New York hospitals, 6 factors predicted 27.6% of readmissions for patients with heart failure (HF). We found that higher admissions per bed, teaching hospitals, and poor nurse-patient communication increased HF readmissions. Conversely, the HF readmissions were lower when nurse staffing was greater, more patients reported receiving discharge information, and among hospitals in California. The implications for nursing practice in the delivery of care to patients with HF are discussed.

The Affordable Care Act is modeled after Massachusetts insurance reforms enacted in 2006. A linear mixed effect model examined trends in patient turnover and nurse employment in Massachusetts, New York, and California nonfederal hospitals from 2000 to 2011. The linear mixed effect analysis found that the rate of increase in hospital admissions was significantly higher in Massachusetts hospitals (p<.001) than that in California and New York (p=.007). The rate of change in registered nurses full-time equivalent hours per patient day was significantly less (p=.02) in Massachusetts than that in California and was not different from zero. The rate of change in admissions to registered nurses full-time equivalent hours per patient day was significantly greater in Massachusetts than California (p=.001) and New York (p<.01). Nurse staffing remained flat in Massachusetts, despite a significant increase in hospital admissions. The implications of the findings for nurse employment and hospital utilization following the implementation of national health insurance reform are discussed.